Endoscopic treatments

Endoscopic treatments are done using an endoscope (a thin, tube-like instrument with a light and lens) placed in the esophagus. You may be offered endoscopic treatments to relieve the symptoms of advanced esophageal cancer, such as difficulty swallowing. This is called palliative therapy. Some endoscopic treatments may also be used to treat precancerous conditions and early stage cancers in the esophagus.

Endoscopic mucosal resection (EMR)

EMR is an endoscopic treatment used to remove small, early stage tumours that are only in the inner layer, or mucosa, of the esophagus and have not spread to the other layers of the esophagus.

The doctor passes an endoscope through the mouth, down the throat and into the esophagus. In some types of EMR, salt water is injected under the tumour to lift it away from the wall of the esophagus. In other types of EMR, the doctor may use suction to lift the tumour away from the wall of the esophagus. The doctor uses a special tool passed through the endoscope to remove the tumour along with a margin of healthy tissue around it. This may be a cutting tool, a tool that cauterizes (burns) the tumour away or a tool with a laser.

After EMR, the healthy tissue removed along with the tumour is examined under a microscope. If cancer cells are found in the tissue, more EMR or treatment with chemotherapy, radiation therapy or photodynamic therapy (PDT) may be needed to completely remove or destroy the cancer.

Photodynamic therapy (PDT)

PDT is treatment with drugs that make cells sensitive to light (called photosensitizers). The doctor gives the drug, which is taken up by cancer cells. Then the doctor uses an endoscope to expose the cancer cells to light.

PDT may be used after EMR to destroy any abnormal cells left behind. It may also be used to treat precancerous conditions and early stage cancers in the esophagus. PDT may be used to treat symptoms of advanced esophageal cancer. This is called palliative PDT.

Laser surgery

Laser surgery uses a laser (an intense beam of light) to make bloodless cuts in tissue. It may be used to treat symptoms of advanced esophageal cancer. This is called palliative laser surgery.

Radiofrequency ablation

Radiofrequency ablation (RFA) uses a high-frequency electrical current to destroy cancer cells. The doctor places an endoscope into the esophagus. A balloon connected to the end of the endoscope is inflated beside the area of the esophagus that will be treated. A high-frequency electrical current is given through the wall of the balloon. The balloon may be moved to treat other abnormal areas in the esophagus.

RFA may be used to treat precancerous conditions of the esophagus. It is also offered as an alternative to surgery for stage 0 esophageal cancers. RFA may also be used to treat symptoms of advanced esophageal cancer, such as difficulty swallowing. This is called palliative RFA.

Electrocoagulation or argon plasma coagulation

Electrocoagulation or argon plasma coagulation may be used to treat precancerous conditions of the esophagus. They may also be used to treat symptoms of advanced esophageal cancer, such as difficulty swallowing. This is called palliative therapy.

These treatments don’t usually cause many side effects. They may cause bleeding, narrowing (stricture) or tearing of the esophagus.

These treatments may not be available at all Canadian centres.

Esophageal dilation

Esophageal dilation is a procedure that opens up an area of narrowing, or stricture, in the esophagus caused by the tumour. Sometimes dilation is used to open up a blockage, or obstruction, before other treatments (such as placing stents) can be done.

The doctor uses an endoscope to pass a dilator down the throat to stretch the narrowed part of the esophagus. There are different types of dilators. Some dilators are flexible tubes. The doctor can use a series of bigger and bigger tubes to open the esophagus. Other types of dilators use a balloon to open the esophagus.

Doctors may need to repeat esophageal dilation several times over several weeks to effectively open the area. In some cases, dilation is only temporary because the blockage can come back.

Esophageal dilation is a relatively safe procedure. The main risk is a hole, or perforation, in the wall of the esophagus, but this is rare.

Esophageal stent

A stent is a metal or plastic tube that is placed in the esophagus to help keep it open. It helps prevent a tumour from completely blocking the esophagus. A stent can also seal leaks caused by fistulas, or abnormal openings, between the trachea (windpipe) and the esophagus.

A stent is often placed using an endoscope. The doctor passes an endoscope through the mouth and into the esophagus. Then the doctor passes the stent through the endoscope and positions it in the esophagus. Before the stent can be inserted, the doctor may need to do esophageal dilation to make an opening through the blockage. After the doctor places the stent, an x-ray is taken to make sure it is in the proper position.

A stent allows you to swallow, but you will need to follow a special diet to help make sure that food doesn’t get stuck in the stent. To reduce this risk, you should:

chew your food thoroughly

avoid fibrous food, such as beef and chicken

drink carbonated beverages with your meals

The main risks of esophageal stents are the tumour growing into the stent, food blocking the stent (food bolus obstruction) or the stent moving out of position so that it needs to be replaced or removed.

Placement of a feeding tube

A feeding tube is used to give someone with esophageal cancer liquid nutrition to help maintain their weight. Medicines may also be given through the feeding tube.

Someone with advanced esophageal cancer may need a feeding tube before surgery, at the time of surgery or while healing after surgery. A feeding tube may also be used if a tumour causes a blockage that can’t be removed or bypassed.

Often a feeding tube is placed during surgery for esophageal cancer. If no surgery is planned then a feeding tube may be placed using an endoscope. The doctor passes an endoscope through the mouth, down the throat and into the stomach. The doctor then uses the endoscope to help guide the placement of the feeding tube. This is called a percutaneous endoscopic gastrostomy (PEG) tube.